Mitigating the Harms of “Health & Wellness” Influencers
If you’ve ever used TikTok or Instagram, your feed has probably been dominated by fitness gurus promoting “body sculpting workouts,” self-proclaimed “diet coaches” analyzing other users’ meals, and scores of people live-posting their “weight loss journeys” to millions of followers. Over the past decade, research on social media’s mental health effects has established significant impacts on negative body image and patterns of disordered eating, particularly among teen girls. These concerning findings suggest that much closer scrutiny of digital health & wellness content is needed.
In online spaces, aesthetic beauty serves as a stand-in for expertise, with influencers often displaying their bodies as evidence that their dieting advice is valuable or that their fitness program really works. Social media’s highly visual culture and emphasis on entertainment incentivizes consumers to devalue more reliable sources of credibility, such as education or experience. Despite extensive documentation of fitness influencers promoting harmful content– from dubious health information to unrealistic body standards–the now multi-billion-dollar influencer marketing industry remains an extremely unregulated environment where the vast majority of unethical conduct goes undetected and unpunished.
Instead of exploring broader regulatory options, most critics’ solutions to these pervasive issues burden individual users with the responsibility to filter out misinformation, listen only to uplifting voices that promote body positivity, and generally protect themselves from the algorithm. Others have proposed policies–such as requiring social media companies to provide eating disorder recovery resources, boost content moderation, or make user reporting easier. However, these options all involve chasing down harmful content on the back-end, at which point many vulnerable users may already have been exposed.
Given the urgency of this issue and the inadequacy of existing solutions, the federal government must make a more intentional effort to crack down on rampant unethical conduct in the health influencer industry. Although most industry professionals are regulated at the state level, the boundless nature of digital space means that online commerce often crosses state lines, and therefore demands more centralized management. The Federal Trade Commission is best positioned to undertake these regulations, given the agency’s current authority over online advertising, and its fundamental mission to protect American consumers from “deceptive or unfair business practices.”
The FTC has already demonstrated a commitment to influencer regulation: in August 2023, it released requirements for influencers to disclose sponsorship relationships more transparently, and has recently escalated enforcement actions against nutrition influencers who were systematically violating those rules. While these stricter disclosure mandates are important to maintain FTC standards for “truth in advertising,” they are insufficient to address misinformation and other harms that are consistently perpetuated by health & wellness influencers even when they aren’t directly selling a specific product.
To act effectively on behalf of consumers, the FTC must first create a broader definition of influencer that captures the full range of marketing activity occurring in the social media health & wellness industry. The agency currently defines an influencer as someone who “works with brands to recommend or endorse products or services in social media,” under the broader category of “endorsers”–those who express an advertising message that consumers are likely to believe reflects their genuine beliefs or opinions. In today’s social media landscape, however, explicit product endorsements are just one of many ways that influencers make money; in the health space, influencers might sell online fitness courses and diet coaching, monetize their own image through public appearances or branded merchandise, collect subscription fees for exclusive content, and earn “bonuses” directly from their host platforms.
Because influencers are always building their own brand, both within and outside of sponsored posts, and regardless of any specific commercial relationships, they should be defined comprehensively as “anyone who uses their social media presence to make money.” This capacious definition–which folds in the similar activities of “content creators”–will allow the FTC to keep pace with rapid shifts in the industry and empower the agency to regulate any harmful or misleading content that influencers broadcast to their audiences for financial gain. For instance, a similarly broad definition of financial institution as any entity “engaging in an activity that is financial in nature or incidental to such financial activities” has allowed the FTC to take swifter action against scams and privacy breaches in the cryptocurrency marketplace.
Nevertheless, the immense scale, informal culture, and diffuse effects of social media environments present staggering challenges for any entity attempting to enforce regulations effectively. There are an estimated 10.2 million influencers on Instagram alone, pumping out an unfathomable volume of content every day. No feasible quantity of staff could conduct a systematic review of all influencer content, and no back-end review process will be nimble enough to catch violations before users are harmed.
To hold influencers accountable proactively while keeping administrative labor more reasonable, the FTC should consider developing an influencer license requirement. The purpose of licensure is to ensure that workers are qualified and competent in their field of practice, and to bind them to a uniform standard of professional ethics. Licenses are mandatory in fields from nursing to cosmetology, and typically involve some combination of training and examination. However, with such a wide variety of activities and content categories under the influencer umbrella, what those requirements might entail for influencers is an open question. Enforcement responsibility also poses a challenge: to what extent would social media companies be liable for hosting unlicensed influencers, and what penalties would the FTC exact for noncompliance?
Developing a fair, effective, and enforceable influencer license will no doubt be a complex process–but given significant threats to youth mental health under the status quo, it is something the FTC should explore. With average incomes in the industry climbing to $58,000 per year as of 2024, it’s time for influencers to be treated as professionals rather than mere individuals exercising their right to free expression on the internet. Increased education and training could raise actual health expertise among influencers and make them more aware of misinformation’s potential consequences, ultimately diminishing the prevalence of noxious content masquerading as health advice online.
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Biography of Author
Rebecca Coyne is a MPP candidate at the University of Michigan’s Ford School of Public Policy. Her interests include science, technology, & information policy.
Edited by: Fransisco Brady, MPP ’25 // Charlotte Hovey, MPP’25
